{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T10:13:51Z","timestamp":1791627231543,"version":"4.3.4"},"reference-count":45,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T00:00:00Z","timestamp":1679356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Recently, the treatment of infected wounds has become a global problem due to increased antibiotic resistance in bacteria. The Gram-negative opportunistic pathogen Pseudomonas aeruginosa is often present in chronic skin infections, and it has become a threat to public health as it is increasingly multidrug resistant. Due to this, new measures to enable treatment of infections are necessary. Treatment of bacterial infections with bacteriophages, known as phage therapy, has been in use for a century, and has potential with its antimicrobial effect. The main purpose of this study was to create a phage-containing wound dressing with the ability to prevent bacterial infection and rapid wound healing without side effects. Several phages against P. aeruginosa were isolated from wastewater, and two polyvalent phages were used to prepare a phage cocktail. The phage cocktail was loaded in a hydrogel composed of polymers of sodium alginate (SA) and carboxymethyl cellulose (CMC). To compare the antimicrobial effects, hydrogels containing phages, ciprofloxacin, or phages plus ciprofloxacin were produced, and hydrogels without either. The antimicrobial effect of these hydrogels was investigated in vitro and in vivo using an experimental mouse wound infection model. The wound-healing process in different mouse groups showed that phage-containing hydrogels and antibiotic-containing hydrogels have almost the same antimicrobial effect. However, in terms of wound healing and pathological process, the phage-containing hydrogels performed better than the antibiotic alone. The best performance was achieved with the phage\u2013antibiotic hydrogel, indicating a synergistic effect between the phage cocktail and the antibiotic. In conclusion, phage-containing hydrogels eliminate efficiently P. aeruginosa in wounds and may be a proper option for treating infectious wounds.<\/jats:p>","DOI":"10.3390\/v15030803","type":"journal-article","created":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T07:46:43Z","timestamp":1679471203000},"page":"803","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Design of Phage-Cocktail\u2013Containing Hydrogel for the Treatment of Pseudomonas aeruginosa\u2013Infected Wounds"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4271-189X","authenticated-orcid":false,"given":"Fatemeh","family":"Shafigh Kheljan","sequence":"first","affiliation":[{"name":"Department of Animal Biology, Faculty of Natural Sciences, University of Tabriz, Tabriz 5166616471, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farzam","family":"Sheikhzadeh Hesari","sequence":"additional","affiliation":[{"name":"Department of Animal Biology, Faculty of Natural Sciences, University of Tabriz, Tabriz 5166616471, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Aminifazl","sequence":"additional","affiliation":[{"name":"Department of Applied Chemistry, Faculty of Chemistry, University of Tabriz, Tabriz 5166616471, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8791-9260","authenticated-orcid":false,"given":"Mikael","family":"Skurnik","sequence":"additional","affiliation":[{"name":"Human Microbiome Research Program, Department of Bacteriology and Immunology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, 00014 HUS Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Goladze","sequence":"additional","affiliation":[{"name":"Human Microbiome Research Program, Department of Bacteriology and Immunology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, 00014 HUS Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1087-0769","authenticated-orcid":false,"given":"Gholamreza","family":"Zarrini","sequence":"additional","affiliation":[{"name":"Department of Animal Biology, Faculty of Natural Sciences, University of Tabriz, Tabriz 5166616471, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Tottoli, E.M., Dorati, R., Genta, I., Chiesa, E., Pisani, S., and Conti, B. (2020). Skin Wound Healing Process and New Emerging Technologies for Skin Wound Care and Regeneration. Pharmaceutics, 12.","DOI":"10.3390\/pharmaceutics12080735"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Negut, I., Grumezescu, V., and Grumezescu, A.M. (2018). Treatment Strategies for Infected Wounds. Molecules, 23.","DOI":"10.3390\/molecules23092392"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"212527","DOI":"10.7573\/dic.212527","article-title":"How to Manage Pseudomonas Aeruginosa Infections","volume":"7","author":"Bassetti","year":"2018","journal-title":"Drugs Context"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.biotechadv.2018.11.013","article-title":"Antibiotic Resistance in Pseudomonas Aeruginosa: Mechanisms and Alternative Therapeutic Strategies","volume":"37","author":"Pang","year":"2019","journal-title":"Biotechnol. Adv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"100640","DOI":"10.1016\/j.drup.2019.07.002","article-title":"Antibiotic Resistance in Pseudomonas Aeruginosa\u2014Mechanisms, Epidemiology and Evolution","volume":"44","author":"Botelho","year":"2019","journal-title":"Drug Resist. Updates"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1002\/med.21593","article-title":"Phage Therapy: Current Status and Perspectives","volume":"40","author":"Borysowski","year":"2020","journal-title":"Med. Res. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Al-Ishaq, R.K., Skariah, S., and B\u00fcsselberg, D. (2021). Bacteriophage Treatment: Critical Evaluation of Its Application on World Health Organization Priority Pathogens. Viruses, 13.","DOI":"10.3390\/v13010051"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1080\/1040841X.2020.1729695","article-title":"Phage Therapy Efficacy: A Review of the Last 10 Years of Preclinical Studies","volume":"46","author":"Melo","year":"2020","journal-title":"Crit. Rev. Microbiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"162","DOI":"10.4292\/wjgpt.v8.i3.162","article-title":"Phage Therapy: An Alternative to Antibiotics in the Age of Multi-Drug Resistance","volume":"8","author":"Lin","year":"2017","journal-title":"World J. Gastrointest. Pharmacol. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Kim, H.Y., Chang, R.Y.K., Morales, S., and Chan, H.K. (2021). Bacteriophage-Delivering Hydrogels: Current Progress in Combating Antibiotic Resistant Bacterial Infection. Antibiotics, 10.","DOI":"10.3390\/antibiotics10020130"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.ejpb.2020.11.019","article-title":"Synergistic Activity of Phage PEV20-Ciprofloxacin Combination Powder formulation\u2014A Proof-of-Principle Study in a P. Aeruginosa Lung Infection Model","volume":"158","author":"Lin","year":"2021","journal-title":"Eur. J. Pharm. Biopharm."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"45","DOI":"10.2147\/IDR.S234353","article-title":"How Phages Overcome the Challenges of Drug Resistant Bacteria in Clinical Infections","volume":"13","author":"Moghadam","year":"2020","journal-title":"Infect. Drug Resist."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Abedon, S.T., Danis-Wlodarczyk, K.M., and Wozniak, D.J. (2021). Phage Cocktail Development for Bacteriophage Therapy: Toward Improving Spectrum of Activity Breadth and Depth. Pharmaceuticals, 14.","DOI":"10.3390\/ph14101019"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"538060","DOI":"10.3389\/fmicb.2020.538060","article-title":"Local Bacteriophage Delivery for Treatment and Prevention of Bacterial Infections","volume":"11","author":"Rotman","year":"2020","journal-title":"Front. Microbiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"102145","DOI":"10.1016\/j.nano.2019.102145","article-title":"Encapsulated Bacteriophages in Alginate-Nanohydroxyapatite Hydrogel as a Novel Delivery System to Prevent Orthopedic Implant-Associated Infections","volume":"24","author":"Barros","year":"2020","journal-title":"Nanomed. Nanotechnol. Biol. Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Narayanaswamy, R., and Torchilin, V.P. (2019). Hydrogels and Their Applications in Targeted Drug Delivery. Molecules, 24.","DOI":"10.3390\/molecules24030603"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"P\u00e9rez-Luna, V.H., and Gonz\u00e1lez-Reynoso, O. (2018). Encapsulation of Biological Agents in Hydrogels for Therapeutic Applications. Gels, 4.","DOI":"10.3390\/gels4030061"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4466","DOI":"10.1016\/j.ijbiomac.2020.08.247","article-title":"Bioactive Multi-Engineered Hydrogel Offers Simultaneous Promise against Antibiotic Resistance and Wound Damage","volume":"164","author":"Zhang","year":"2020","journal-title":"Int. J. Biol. Macromol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"118779","DOI":"10.1016\/j.ijpharm.2019.118779","article-title":"A Novel Wound Dressing Consisting of PVA-SA Hybrid Hydrogel Membrane for Topical Delivery of Bacteriophages and Antibiotics","volume":"572","author":"Kaur","year":"2019","journal-title":"Int. J. Pharm."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e00203","DOI":"10.1128\/JCM.00203-19","article-title":"Understanding and Addressing CLSI Breakpoint Revisions: A Primer for Clinical Laboratories","volume":"57","author":"Humphries","year":"2019","journal-title":"J. Clin. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Clokie, M.R.J., and Kropinski, A.M. (2009). Bacteriophages: Methods and Protocols, Humana Press. r1588296822 (hbk.).","DOI":"10.1007\/978-1-60327-164-6"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"169","DOI":"10.21767\/AMJ.2016.2642","article-title":"Characterization and Lytic Activity of Methicillin-Resistant Staphylococcus aureus (MRSA) Phages Isolated from NICU","volume":"9","author":"Rahimzadeh","year":"2016","journal-title":"Australas. Med. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"15603","DOI":"10.1038\/s41598-021-95132-1","article-title":"Encapsulation of Bacteriophage Cocktail into Chitosan for the Treatment of Bacterial Diarrhea","volume":"11","author":"Rahimzadeh","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1093\/bioinformatics\/btu661","article-title":"A5-Miseq: An Updated Pipeline to Assemble Microbial Genomes from Illumina MiSeq Data","volume":"31","author":"Coil","year":"2015","journal-title":"Bioinformatics"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"8292","DOI":"10.1038\/s41598-017-07910-5","article-title":"PhageTerm: A Tool for Fast and Accurate Determination of Phage Termini and Packaging Mechanism Using next-Generation Sequencing Data","volume":"7","author":"Garneau","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Aziz, R.K., Bartels, D., Best, A., DeJongh, M., Disz, T., Edwards, R.A., Formsma, K., Gerdes, S., Glass, E.M., and Kubal, M. (2008). The RAST Server: Rapid Annotations Using Subsystems Technology. BMC Genom., 9.","DOI":"10.1186\/1471-2164-9-75"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1093\/bioinformatics\/btr703","article-title":"Artemis: An Integrated Platform for Visualization and Analysis of High-Throughput Sequence-Based Experimental Data","volume":"28","author":"Carver","year":"2012","journal-title":"Bioinformatics"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.carbpol.2007.12.008","article-title":"Investigation of PVA\/ws-Chitosan Hydrogels Prepared by Combined \u03b3-Irradiation and Freeze-Thawing","volume":"73","author":"Yang","year":"2008","journal-title":"Carbohydr. Polym."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1016\/j.ijbiomac.2020.11.014","article-title":"Development of Nanosilver Doped Carboxymethyl Chitosan-Polyamideamine Alginate Composite Dressing for Wound Treatment","volume":"166","author":"Zhou","year":"2021","journal-title":"Int. J. Biol. Macromol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/S0939-6411(01)00191-6","article-title":"A New Lipid Emulsion Formulation with High Antimicrobial Efficacy Using Chitosan","volume":"53","author":"Jumaa","year":"2002","journal-title":"Eur. J. Pharm. Biopharm."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1101\/pdb.prot073411","article-title":"Manual Hematoxylin and Eosin Staining of Mouse Tissue Sections","volume":"2014","author":"Cardiff","year":"2014","journal-title":"Cold Spring Harb. Protoc."},{"key":"ref_32","first-page":"203","article-title":"Phage Therapy in Treatment of Gram-Negative Bacterial Infections: A Systematic Review","volume":"28","author":"Rahimzadeh","year":"2018","journal-title":"J. Maz. Univ. Med. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/1751-7915.12316","article-title":"A Novel Bacteriophage Cocktail Reduces and Disperses Pseudomonas Aeruginosa Biofilms under Static and Flow Conditions","volume":"9","author":"Alves","year":"2016","journal-title":"Microb. Biotechnol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.2217\/fmb.10.66","article-title":"Bacteriophages of Pseudomonas","volume":"5","author":"Ceyssens","year":"2010","journal-title":"Future Microbiol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Essoh, C., Latino, L., Midoux, C., Blouin, Y., Loukou, G., Nguetta, S.P.A., Lathro, S., Cablanmian, A., Kouassi, A.K., and Vergnaud, G. (2015). Investigation of a Large Collection of Pseudomonas Aeruginosa Bacteriophages Collected from a Single Environmental Source in Abidjan, C\u00f4te d\u2019Ivoire. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0130548"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3239","DOI":"10.1007\/s00705-021-05205-9","article-title":"Bacterial Viruses Subcommittee and Archaeal Viruses Subcommittee of the ICTV: Update of Taxonomy Changes in 2021","volume":"166","author":"Krupovic","year":"2021","journal-title":"Arch. Virol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.cis.2017.05.014","article-title":"Formulation, Stabilisation and Encapsulation of Bacteriophage for Phage Therapy","volume":"249","author":"Malik","year":"2017","journal-title":"Adv. Colloid Interface Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.eurpolymj.2014.11.024","article-title":"Biomedical Applications of Hydrogels: A Review of Patents and Commercial Products","volume":"65","author":"Khutoryanskiy","year":"2015","journal-title":"Eur. Polym. J."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Jacob, S., Nair, A.B., Shah, J., Sreeharsha, N., Gupta, S., and Shinu, P. (2021). Emerging Role of Hydrogels in Drug Delivery Systems, Tissue Engineering and Wound Management. Pharmaceutics, 13.","DOI":"10.3390\/pharmaceutics13030357"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3933","DOI":"10.1002\/adfm.201304202","article-title":"A Novel Wound Dressing Based on Ag\/graphene Polymer Hydrogel: Effectively Kill Bacteria and Accelerate Wound Healing","volume":"24","author":"Fan","year":"2014","journal-title":"Adv. Funct. Mater."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.carbpol.2018.05.078","article-title":"Influence of Different Divalent Ions Cross-Linking Sodium Alginate-Polyacrylamide Hydrogels on Antibacterial Properties and Wound Healing","volume":"197","author":"Zhou","year":"2018","journal-title":"Carbohydr. Polym."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1016\/j.xphs.2017.02.031","article-title":"Gentamicin-Loaded Thermosetting Hydrogel and Moldable Composite Scaffold: Formulation Study and Biologic Evaluation","volume":"106","author":"Dorati","year":"2017","journal-title":"J. Pharm. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Zhang, K., Wang, Y., Wei, Q., Li, X., Guo, Y., and Zhang, S. (2021). Design and Fabrication of Sodium Alginate\/carboxymethyl Cellulose Sodium Blend Hydrogel for Artificial Skin. Gels, 7.","DOI":"10.3390\/gels7030115"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Klunklin, W., Jantanasakulwong, K., Phimolsiripol, Y., Leksawasdi, N., Seesuriyachan, P., Chaiyaso, T., Insomphun, C., Phongthai, S., Jantrawut, P., and Sommano, S.R. (2021). Synthesis, Characterization, and Application of Carboxymethyl Cellulose from Asparagus Stalk End. Polymers, 13.","DOI":"10.3390\/polym13010081"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.ijpharm.2018.09.024","article-title":"Synergy of Nebulized Phage PEV20 and Ciprofloxacin Combination against Pseudomonas Aeruginosa","volume":"551","author":"Lin","year":"2018","journal-title":"Int. J. Pharm."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/3\/803\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:00:01Z","timestamp":1760122801000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/15\/3\/803"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,21]]},"references-count":45,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["v15030803"],"URL":"https:\/\/doi.org\/10.3390\/v15030803","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,21]]}}}